An assessment of equity in the distribution of non-financial health care inputs across public primary health care facilities in Tanzania

International Journal for Equity in Health

Research

August Kuwawenaruwa¹  Gemini Mtei¹  Michelle Remme²  Josephine Borghi² 

[1] Ifakara Health Institute, P.O. Box 78 373, Plot 463, Kiko Avenue Mikocheni, Dar es Salaam, Tanzania;Ifakara Health Institute, P.O. Box 78 373, Plot 463, Kiko Avenue Mikocheni, Dar es Salaam, Tanzania;Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK;

关键词: Equity;    Distribution;    Health care inputs;    Tanzania;   

DOI  :  10.1186/s12939-017-0620-0

 received in 2016-07-29, accepted in 2017-07-04,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundThere is limited evidence on how health care inputs are distributed from the sub-national level down to health facilities and their potential influence on promoting health equity. To address this gap, this paper assesses equity in the distribution of health care inputs across public primary health facilities at the district level in Tanzania.MethodsThis is a quantitative assessment of equity in the distribution of health care inputs (staff, drugs, medical supplies and equipment) from district to facility level. The study was carried out in three districts (Kinondoni, Singida Rural and Manyoni district) in Tanzania. These districts were selected because they were implementing primary care reforms. We administered 729 exit surveys with patients seeking out-patient care; and health facility surveys at 69 facilities in early 2014. A total of seventeen indices of input availability were constructed with the collected data. The distribution of inputs was considered in relation to (i) the wealth of patients accessing the facilities, which was taken as a proxy for the wealth of the population in the catchment area; and (ii) facility distance from the district headquarters. We assessed equity in the distribution of inputs through the use of equity ratios, concentration indices and curves.ResultsWe found a significant pro-rich distribution of clinical staff and nurses per 1000 population. Facilities with the poorest patients (most remote facilities) have fewer staff per 1000 population than those with the least poor patients (least remote facilities): 0.6 staff per 1000 among the poorest, compared to 0.9 among the least poor; 0.7 staff per 1000 among the most remote facilities compared to 0.9 among the least remote. The negative concentration index for support staff suggests a pro-poor distribution of this cadre but the 45 degree dominated the concentration curve. The distribution of vaccines, antibiotics, anti-diarrhoeal, anti-malarials and medical supplies was approximately proportional (non dominance), whereas the distribution of oxytocics, anti-retroviral therapy (ART) and anti-hypertensive drugs was pro-rich, with the 45 degree line dominating the concentration curve for ART.ConclusionThis study has shown there are inequities in the distribution of health care inputs across public primary care facilities. This highlights the need to ensure a better coordinated and equitable distribution of inputs through regular monitoring of the availability of health care inputs and strengthening of reporting systems.

【 授权许可】

CC BY   
© The Author(s). 2017